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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

Rethinking the Local Therapy of Breast Cancer: Integration of Biology and Anatomy

Author: Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 10/2015

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Abstract

Local control has traditionally been considered a function of disease burden. Local control is now known to differ among biologic subtypes of breast cancer and is greatly improved with the use of systemic therapy. This offers opportunities for decreasing the morbidity of treatment and individualizing local therapy. The use of smaller margins in breast-conserving surgery and elimination of axillary dissection for some node-positive breast cancer patients are current examples of leveraging the benefits of systemic therapy to reduce surgery. Emerging evidence indicates that molecular profiling can identify patients at high and low risk for locoregional recurrence after surgery in a more accurate way than tumor burden, potentially allowing individualization of the use of postmastectomy and comprehensive node field irradiation. Future clinical trials should incorporate both disease burden and molecular profiling when examining treatment strategies.
Literature
1.
Adair F, Berg J, Joubert L, et al. Long-term followup of breast cancer patients: the 30-year report. Cancer. 1974;33(4):1145–50.CrossRefPubMed
2.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.CrossRefPubMed
3.
Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75.CrossRefPubMed
4.
Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.CrossRefPubMed
5.
Wiechmann L, Sampson M, Stempel M, et al. Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 2009;16(10):2705–10.CrossRefPubMed
6.
Ugras S, Stempel M, Patil S, et al. Estrogen receptor, progesterone receptor, and HER2 status predict lymphovascular invasion and lymph node involvement. Ann Surg Oncol. 2014;21(12):3780–6.CrossRefPubMed
7.
Lowery AJ, Kell MR, Glynn RW, et al. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2012;133(3):831–41.CrossRefPubMed
8.
Cancello G, Maisonneuve P, Rotmensz N, et al. Prognosis in women with small (T1mic, T1a, T1b) node-negative operable breast cancer by immunohistochemically selected subtypes. Breast Cancer Res Treat. 2011;127(3):713–20.CrossRefPubMed
9.
Millar EK, Graham PH, O’Toole SA, et al. Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol. 2009;27(28):4701–8.CrossRefPubMed
10.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRef
11.
Mannino M, Yarnold JR. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol. 2009;90(1):14–22.CrossRefPubMed
12.
Kiess AP, McArthur HL, Mahoney K, et al. Adjuvant trastuzumab reduces locoregional recurrence in women who receive breast-conservation therapy for lymph node-negative, human epidermal growth factor receptor 2-positive breast cancer. Cancer. 2012;118(8):1982–8.CrossRefPubMed
13.
Lanning RM, Morrow M, Riaz N, et al. The effect of adjuvant trastuzumab on locoregional recurrence of human epidermal growth factor receptor 2-positive breast cancer treated with mastectomy. Ann Surg Oncol. 2015.
14.
Bouganim N, Tsvetkova E, Clemons M, et al. Evolution of sites of recurrence after early breast cancer over the last 20 years: implications for patient care and future research. Breast Cancer Res Treat. 2013;139(2):603–6.CrossRefPubMed
15.
Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704–16.CrossRefPubMed
16.
Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.PubMedCentralCrossRefPubMed
17.
Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.CrossRefPubMed
18.
Houssami N, Macaskill P, Marinovich ML, et al. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717–30.CrossRefPubMed
19.
Pilewskie M, Ho A, Orell E, et al. Effect of margin width on local recurrence in triple-negative breast cancer patients treated with breast-conserving therapy. Ann Surg Oncol. 2014;21(4):1209–14.PubMedCentralCrossRefPubMed
20.
Abdulkarim BS, Cuartero J, Hanson J, et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. J Clin Oncol. 2011;29(21):2852–8.CrossRefPubMed
21.
Adkins FC, Gonzalez-Angulo AM, Lei X, et al. Triple-negative breast cancer is not a contraindication for breast conservation. Ann Surg Oncol. 2011;18(11):3164–73.PubMedCentralCrossRefPubMed
22.
Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013;20(11):3469–76.CrossRefPubMed
23.
24.
McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467–75.CrossRefPubMed
25.
Greenup RA, Peppercorn J, Worni M, et al. Cost implications of the SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Ann Surg Oncol. 2014;21(5):1512–4.CrossRefPubMed
26.
Chung A, Gangi A, Mirocha J, et al. Applicability of the ACOSOG Z0011 criteria in women with high-risk node-positive breast cancer undergoing breast conserving surgery. Ann Surg Oncol. 2015;22(4):1128–32.CrossRefPubMed
27.
Dengel LT, Van Zee KJ, King TA, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol. 2014;21(1):22–7.PubMedCentralCrossRefPubMed
28.
McBride A, Allen P, Woodward W, et al. Locoregional recurrence risk for patients with T1,2 breast cancer with 1-3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys. 2014;89(2):392–8.CrossRefPubMed
29.
Moo TA, McMillan R, Lee M, et al. Selection criteria for postmastectomy radiotherapy in t1–t2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol. 2013;20(10):3169–74.CrossRefPubMed
30.
Whelan T, Olivotto I, Parulekar WR et al. Regional nodal irradiation in early stage breast cancer. N Engl J Med. 2015;373:307–16.CrossRefPubMed
31.
Poortmans P, Collete S, Kirkove C et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317–27.
32.
Mamounas EP, Tang G, Fisher B, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol. 2010;28(10):1677–83.PubMedCentralCrossRefPubMed
33.
Mamounas E, Tang G, Paik S, et al. The 21-gene recurrence score (RS) predicts risk of loco-regional recurrence (LRR) in node (+), ER (+) breast cancer (BC) after adjuvant chemotherapy and tamoxifen: results from NSABP B-28. (Presented at the Society of Surgical Oncology 66th Annual Cancer Symposium, National Harbor, Maryland, 2013). Ann Surg Oncol. 2013;20:S6–S164.
34.
Tramm T, Mohammed H, Myhre S, et al. Development and validation of a gene profile predicting benefit of postmastectomy radiotherapy in patients with high-risk breast cancer: a study of gene expression in the DBCG82bc cohort. Clin Cancer Res. 2014;20(20):5272–80.CrossRefPubMed
Metadata
Title
Rethinking the Local Therapy of Breast Cancer: Integration of Biology and Anatomy
Author
Monica Morrow, MD
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4750-6

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